| NPI | 1093164386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO195314) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A15781) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2020-01-23 |