| NPI | 1376984021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C183981) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 306663) |
| 207Q00000X Family Medicine (Licence: OR MD177129) | |
| 207Q00000X Family Medicine (Licence: MI 4301103809) | |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2023-11-08 |