| NPI | 1740202134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A91698) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-13503) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-11-29 |