| NPI | 1083652846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA md00033883) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G45192) |
| 207Q00000X Family Medicine (Licence: ID m7091) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2019-07-24 |