| NPI | 1730115627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2009-0731) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 22879) |
| 207Q00000X Family Medicine (Licence: CA G84864) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2020-09-18 |