| NPI | 1164436259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A101551) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD070654L) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-01-10 |