| NPI | 1811376908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C187365) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 18832) |
| 207Q00000X Family Medicine (Licence: AL 38022) | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2023-08-31 |