| NPI | 1417937509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61234128) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A82324) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2022-06-30 |