| NPI | 1376685867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C145588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036121484) |
| 207Q00000X Family Medicine (Licence: TX n6650) | |
| 207Q00000X Family Medicine (Licence: OK 24601) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-04-29 |