| NPI | 1184018079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18844) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 186248) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2024-01-19 |