| NPI | 1265061154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 186953) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NV 25600) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2024-07-15 |