| NPI | 1104885300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G88658) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD025659E) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2016-02-29 |