| NPI | 1871566679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C193020) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ID M6640) |
| 207Q00000X Family Medicine (Licence: WA 00034412) | |
| 207Q00000X Family Medicine (Licence: WA MD00034412) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2024-02-27 |