| NPI | 1023014651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A80197) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60657225) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2020-10-09 |