| NPI | 1043745821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA A164802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60756248) |
| 207Q00000X Family Medicine (Licence: WA MD60963491) | |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2022-04-20 |