| NPI | 1124558465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61176284) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A158654) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2021-11-24 |