| NPI | 1669095741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A22149) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR D0227314) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2026-01-22 |