| NPI | 1912071556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A96427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 73146) |
| 207Q00000X Family Medicine (Licence: NV 26450) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2025-06-30 |