| NPI | 1215977202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C52899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD419312) |
| 207Q00000X Family Medicine (Licence: WA MD60140025) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2020-12-07 |