| NPI | 1295881175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A96695) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-12799) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2021-12-01 |