| NPI | 1093000556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-01948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 66753-20) |
| 207Q00000X Family Medicine (Licence: CA A130639) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2022-06-29 |