| NPI | 1205835840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-02202) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60314252) |
| 207Q00000X Family Medicine (Licence: CA C146974) | |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2021-07-23 |