| NPI | 1134491459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 250) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A 4091) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2012-02-01 |