| NPI | 1962438341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G88817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 23375) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2022-03-23 |