| NPI | 1841781812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A194474) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61142151) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2024-08-01 |