| NPI | 1003109448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A156322) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014022133) |
| 207Q00000X Family Medicine (Licence: ND RL11900) | |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2018-10-24 |