| NPI | 1063092369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 011200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A21101) |
| Enumeration Date | 2021-04-11 |
| Last Update Date | 2024-09-13 |