| NPI | 1841468600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60076561) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A102179) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2009-11-04 |