| NPI | 1164456802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G58243) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 226822) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-05-28 |