| NPI | 1639301369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A127099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7324) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2023-07-10 |