| NPI | 1467613588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 146911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 26055) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2018-08-28 |