| NPI | 1639799273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A184398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61425075) |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2025-02-04 |