| NPI | 1770901043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 138662) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD.MD.70009746) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2026-07-29 |