| NPI | 1336349216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A98854) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 40481) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2021-12-02 |