| NPI | 1184652943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60797979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A84838) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2021-05-25 |