| NPI | 1144300534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A68184) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 49570) |
| 207Q00000X Family Medicine (Licence: MI 4301061917) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2023-03-07 |