| NPI | 1831110519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A69293) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 10604) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2025-11-12 |