| NPI | 1598862914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A75755) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 11369) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-07-26 |