| NPI | 1457410110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60644369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G42527) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2022-10-14 |