| NPI | 1467740662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A134487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML60229055) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2015-03-06 |