| NPI | 1184816688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A110238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301090736) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2021-06-09 |