| NPI | 1992969703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C157200) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 14082) |
| 207Q00000X Family Medicine (Licence: IA 39169) | |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2019-12-17 |