| NPI | 1811937824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G88783) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00021697) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2011-11-01 |