| NPI | 1437617099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 010788) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 19984) |
| Enumeration Date | 2019-03-03 |
| Last Update Date | 2024-05-21 |