| NPI | 1609904507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 5017) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2022-08-08 |