| NPI | 1770670556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A107382) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00046865) |
| 207Q00000X Family Medicine (Licence: AZ 37772) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2023-03-07 |