| NPI | 1417268780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 171689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250807) |
| 207Q00000X Family Medicine (Licence: TX S6745) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2022-08-10 |