| NPI | 1235384058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A114892) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 14939) |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2015-12-10 |