| NPI | 1619948502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G65072) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 31454) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2014-08-11 |