| NPI | 1558624957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A16207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV d01985) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2019-11-06 |