| NPI | 1508430968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 201333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R78625) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2025-04-03 |