| NPI | 1891043832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 14497) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A135372) |
| Enumeration Date | 2012-08-23 |
| Last Update Date | 2024-04-24 |