| NPI | 1073846762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A109454) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 48330) |
| Enumeration Date | 2009-09-12 |
| Last Update Date | 2014-12-02 |