| NPI | 1265425326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G89420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00021005) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2016-03-01 |