| NPI | 1528012028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00046649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 89965) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2023-10-19 |