| NPI | 1083770754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 97231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD153089) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2019-02-25 |