| NPI | 1912946757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61235421) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G58102) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2026-04-13 |