| NPI | 1215236443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A130204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 27699) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2020-08-03 |