| NPI | 1578740684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A14864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO173027) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2016-10-02 |