| NPI | 1649316332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C39620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-21441) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2023-09-20 |