| NPI | 1235562158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A151904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60913447) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2023-07-17 |