| NPI | 1174902936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A159104) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 159104) |
| 207Q00000X Family Medicine (Licence: PA MD463692) | |
| 207Q00000X Family Medicine (Licence: GA 85231) | |
| 207Q00000X Family Medicine (Licence: AZ 57263) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2023-10-26 |