| NPI | 1811320179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60662927) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME151517) |
| 207P00000X Emergency Medicine (Licence: WA MD60662927) | |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2023-12-18 |