| NPI | 1841580263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A15005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR DO165788) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2021-12-02 |