| NPI | 1679551873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A7975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 945) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-11-24 |