| NPI | 1235282559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A8919) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO160321) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-11-07 |