| NPI | 1114157179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 15998) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A118819) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2018-07-05 |