| NPI | 1952663122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A139757) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL MD.41195) |
| 207Q00000X Family Medicine (Licence: IA R-9522) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2020-07-24 |