| NPI | 1770571887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00044362) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00044362) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2025-08-04 |