| NPI | 1508874207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C171928) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 17634) |
| 207Q00000X Family Medicine (Licence: WA MD00048053) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-09-20 |