| NPI | 1346370137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A89225) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 20260) |
| 207Q00000X Family Medicine (Licence: AL 43761) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2022-02-02 |