| NPI | 1437684255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP61621022) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A18486) |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2024-11-29 |