| NPI | 1114235744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A150771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-16580) |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2020-10-02 |