| NPI | 1831196112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C 52030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00041393) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2021-12-03 |