| NPI | 1740254556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO170187) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10683) |
| 207Q00000X Family Medicine (Licence: NM A145708) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2015-07-13 |