| NPI | 1215370846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A174580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116028936) |
| 207Q00000X Family Medicine (Licence: KY 52598) | |
| Enumeration Date | 2013-04-13 |
| Last Update Date | 2022-04-14 |