| NPI | 1295814325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G69898) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD217347) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2025-09-18 |