| NPI | 1174791677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA a106130) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 43010886368) |
| 207Q00000X Family Medicine (Licence: NJ 25ma08403600) | |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2012-06-18 |