| NPI | 1205964947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A108177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 13294) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2025-11-20 |