| NPI | 1255387148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 02882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 22993) |
| 207Q00000X Family Medicine (Licence: NE 223) | |
| 207Q00000X Family Medicine (Licence: AZ 008715) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2024-10-17 |