| NPI | 1720290463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60312094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A80846) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2013-06-12 |