| NPI | 1457387482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A4941) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 1207) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2019-11-15 |