| NPI | 1063749802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD154918) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A110000) |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2011-09-14 |