| NPI | 1083771489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A55855) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A055855) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2012-11-08 |