| NPI | 1285611699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A100831) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD6030955) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2022-11-28 |