| NPI | 1588631337 |
|---|---|
| Former Name | KENNETH JOHN NEIL MATWICHUK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-02371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD059269L) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2016-03-25 |