| NPI | 1174768816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A136334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 49096) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2015-08-18 |