| NPI | 1669891479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A15748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG167651) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2017-11-02 |