| NPI | 1386821569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A120630) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 42541) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2022-02-21 |