| NPI | 1902819451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD00035841) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR OR MD 15755) |
| 207P00000X Emergency Medicine (Licence: WA MD00035841) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA MD00035841) | |
| 207Q00000X Family Medicine (Licence: WA MD00035841) | |
| 207P00000X Emergency Medicine (Licence: WA WA MD00035841) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2022-10-06 |