| NPI | 1417634833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP70126781) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A23974) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2026-07-22 |