| NPI | 1023105178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20a10871) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00001628) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2013-03-14 |