| NPI | 1598726895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C53960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD062276L) |
| 207Q00000X Family Medicine (Licence: WA md60067048) | |
| 207Q00000X Family Medicine (Licence: OR MD125579) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2021-12-15 |