| NPI | 1497946313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C146564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD038207) |
| 207Q00000X Family Medicine (Licence: WA MD60041376) | |
| 207Q00000X Family Medicine (Licence: MA 257688) | |
| 208D00000X General Practice (Licence: ZZ MED5708) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2018-03-19 |