| NPI | 1942284831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A66851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60183294) |
| Enumeration Date | 2005-12-03 |
| Last Update Date | 2023-08-22 |