| NPI | 1194814277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A82123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME93390) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2016-06-20 |