| NPI | 1184697559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A78621) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 30074) |
| 207Q00000X Family Medicine (Licence: SD 4353) | |
| 207Q00000X Family Medicine (Licence: NE 19520) | |
| 207Q00000X Family Medicine (Licence: IA 30074) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2018-03-17 |