| NPI | 1407219546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 173060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60939843) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2022-01-11 |