| NPI | 1295939163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV DO1587) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10567) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-02-04 |