| NPI | 1881048965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A174389) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 57936) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2021-11-14 |