| NPI | 1225078363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G142894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A142894) |
| 207Q00000X Family Medicine (Licence: AZ 23369) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-07-28 |