| NPI | 1033198767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 16348) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A5129) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2016-09-20 |