| NPI | 1982675427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A13285) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 1251) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2014-09-19 |