| NPI | 1548614563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20a17139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS15085) |
| 207Q00000X Family Medicine (Licence: AZ 007993) | |
| 207Q00000X Family Medicine (Licence: NV DO2524) | |
| 207R00000X Internal Medicine (Licence: CA 20A17139) | |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2022-09-01 |