| NPI | 1124227772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A106987) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4301090843) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2021-11-30 |