| NPI | 1194704122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A127285) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 27130) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2019-11-11 |