| NPI | 1174574560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A8685) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 47811-021) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2019-08-29 |