| NPI | 1487695466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 20627) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A73348) |
| 207Q00000X Family Medicine (Licence: MA 246006) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-10-17 |