| NPI | 1033198288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A93687) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00026962) |
| 207Q00000X Family Medicine (Licence: GA 056893) | |
| 207Q00000X Family Medicine (Licence: MA 227144) | |
| 207Q00000X Family Medicine (Licence: FL ME96689) | |
| Enumeration Date | 2006-01-15 |
| Last Update Date | 2012-08-28 |