| NPI | 1437288073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A98867) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2007-0234) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2023-07-18 |