| NPI | 1699345421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A196854) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61560027) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2024-12-31 |