| NPI | 1790847952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00023951) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD00023951) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-08 |