| NPI | 1821103854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A10268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4374) |
| 207Q00000X Family Medicine (Licence: WA OP60690694) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2019-10-22 |