| NPI | 1720087141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A14721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA OP00001580) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2017-03-30 |