| NPI | 1760475362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-00773) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G78675) |
| 207Q00000X Family Medicine (Licence: VA 0101243098) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2024-01-12 |