| NPI | 1710999529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-01803) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A5629) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2022-09-01 |