| NPI | 1932155561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00037081) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00037081) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: WA MD00037081) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2015-04-17 |