| NPI | 1447329883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C187582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60598832) |
| 207Q00000X Family Medicine (Licence: GU M-1279) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-10-06 |