| NPI | 1972562841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-11434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60249816) |
| 207Q00000X Family Medicine (Licence: CA A75261) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2021-11-30 |