| NPI | 1659351203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A8559) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203388) |
| 207Q00000X Family Medicine (Licence: PA OS011223) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2021-11-29 |