| NPI | 1649684010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A170150) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60675917) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2021-11-29 |