| NPI | 1790893220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 105384) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML20008414) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2009-01-06 |