| NPI | 1871113050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A178286) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD61411462) |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2025-12-03 |