| NPI | 1700959780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60553847) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A74311) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2024-04-09 |