| NPI | 1205256955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A139570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60849399) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2022-08-02 |