| NPI | 1376533760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GU M-1568) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A93028) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2025-03-06 |