| NPI | 1184782302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102201120) |
| 207Q00000X Family Medicine (Licence: WA OP60091631) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2023-03-07 |