| NPI | 1508027103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A061707) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 23627) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2024-02-20 |