| NPI | 1558371435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO173090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A7931) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2020-09-28 |