| NPI | 1972789774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C176841) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD60129126) |
| 207Q00000X Family Medicine (Licence: AZ 80774) | |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2024-04-03 |