| NPI | 1528562204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 174627) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61072586) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2021-09-24 |