| NPI | 1003134560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A125799) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 0000000000000) |
| Enumeration Date | 2010-05-08 |
| Last Update Date | 2022-03-16 |