| NPI | 1396273132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61369426) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A165590) |
| 207Q00000X Family Medicine (Licence: IN 01085038A) | |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2022-10-24 |