| NPI | 1497800916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A9537) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 8736) |
| 207Q00000X Family Medicine (Licence: NC 2008-01299) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2023-06-08 |