| NPI | 1205032687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C175784) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2010-0591) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2022-05-12 |