| NPI | 1164780052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A171687) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 62697) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2022-01-13 |