| NPI | 1396189288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 15004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OL60366711) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2016-09-29 |