| NPI | 1528087400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO150435) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A8302) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2022-02-04 |