| NPI | 1902875099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00021780) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA 21780) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2013-09-19 |