| NPI | 1841568425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO 1799) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2024-03-29 |