| NPI | 1194791640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD29323) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD29323) |
| 207Q00000X Family Medicine (Licence: CA A78764) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2022-01-16 |