| NPI | 1598727216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 18507) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3594) |
| 207Q00000X Family Medicine (Licence: HI DOS-1872) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2025-03-17 |