| NPI | 1902973662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOS1617) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A7912) |
| 207Q00000X Family Medicine (Licence: WA OP6005980) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2018-09-28 |