| NPI | 1649255282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C54517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-094244) |
| 207Q00000X Family Medicine (Licence: HI MD10976) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2021-12-15 |