| NPI | 1154335966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A77141) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 5431) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2023-03-07 |