| NPI | 1912290982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 007522) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A11618) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2021-03-22 |