| NPI | 1417118118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005317) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U1731) |
| 207Q00000X Family Medicine (Licence: WA 61103612) | |
| 207Q00000X Family Medicine (Licence: CA 20A19258) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2023-06-23 |