| NPI | 1235440330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60287601) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C170078) |
| 207Q00000X Family Medicine (Licence: OR MD179582) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2023-11-11 |