| NPI | 1760467997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G42278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 11721) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2014-07-16 |