| NPI | 1609173996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A119268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61690708) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2026-08-05 |