| NPI | 1215946355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 18094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C20004476) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2022-06-21 |