| NPI | 1003136979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60366594) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A119516) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2026-06-17 |