| NPI | 1174935738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A15655) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2020-06-15 |