| NPI | 1598914384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 43757) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A104387) |
| 207Q00000X Family Medicine (Licence: WA MD60644231) | |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2021-01-21 |