| NPI | 1215993456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A87152) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A87152) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2011-02-24 |