| NPI | 1265894067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C196683) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60856480) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2026-07-09 |