| NPI | 1033179254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11653) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 434) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2020-02-20 |