| NPI | 1770512204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C56187) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K8990) |
| 207Q00000X Family Medicine (Licence: WA MD60122586) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-01-22 |