| NPI | 1104818491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 38341) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2014-06-16 |