| NPI | 1376516260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101230868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C159147) |
| 207Q00000X Family Medicine (Licence: SC 81686) | |
| 207Q00000X Family Medicine (Licence: AR E-11833) | |
| 207Q00000X Family Medicine (Licence: NC 201803048) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2024-03-25 |