| NPI | 1669080560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A198649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2020-0704) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2024-10-29 |