| NPI | 1104022581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A110685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2012-00777) |
| 207Q00000X Family Medicine (Licence: NM rs20070324) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2023-09-14 |