| NPI | 1871596346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60310747) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA MD60310747) |
| 207Q00000X Family Medicine (Licence: MN 42142) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2021-09-28 |