| NPI | 1578589115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C167687) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R1038) |
| 207Q00000X Family Medicine (Licence: NV 12502) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2023-03-07 |