| NPI | 1386708196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00025363) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G38105) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2013-09-06 |