| NPI | 1346496494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C148938) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00048969) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2019-12-09 |