| NPI | 1710418280 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A169976) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MDRE.MD.60958291) |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2025-01-23 |