| NPI | 1215913876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A103333) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 41754) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2015-09-22 |