| NPI | 1023265816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A123645) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR LL17603) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2013-11-26 |