| NPI | 1487681417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD209589) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G67840) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2025-05-13 |