| NPI | 1750874251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A182486) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WA MD61089367) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2024-07-09 |