| NPI | 1467427443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60697846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 12953) |
| 207Q00000X Family Medicine (Licence: CA G84986) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2020-06-10 |