| NPI | 1831393461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-9060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C29102) |
| 207Q00000X Family Medicine (Licence: WA MD60001789) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2021-05-10 |