| NPI | 1629451315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 011028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A15879) |
| 207Q00000X Family Medicine (Licence: NV DO02543) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2024-09-04 |