| NPI | 1346878717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 25751) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A191713) |
| 207Q00000X Family Medicine (Licence: AR E-14974) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2024-09-19 |