| NPI | 1922055300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00031188) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00031188) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2014-06-16 |