| NPI | 1164840856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A158035) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A158035) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2019-12-03 |