| NPI | 1780779413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00022890) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00022890) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-12-21 |