| NPI | 1629017165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 10042) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A84209) |
| 207Q00000X Family Medicine (Licence: WA MD00036020) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-12-12 |