| NPI | 1871957415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD.213324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD.61410502) |
| 207Q00000X Family Medicine (Licence: CA A166860) | |
| Enumeration Date | 2016-04-10 |
| Last Update Date | 2024-11-13 |