| NPI | 1922043512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD00028884) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00028884) |
| 207Q00000X Family Medicine (Licence: WA MD00028884) | |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2014-05-14 |