| NPI | 1922194174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G64321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD203193) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2023-03-07 |