| NPI | 1255562195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 122567) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 13915) |
| 207Q00000X Family Medicine (Licence: NV 13915) | |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2021-10-27 |