| NPI | 1578547576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G27015) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY G27015) |
| 207Q00000X Family Medicine (Licence: OR MD28462) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2021-07-20 |