| NPI | 1962495994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA OP00002016) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00002016) |
| 207Q00000X Family Medicine (Licence: ID o-0442) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2013-07-11 |