| NPI | 1659338473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C161766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9701302) |
| 207Q00000X Family Medicine (Licence: AL 28145) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-10-10 |