| NPI | 1225140759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A101609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 35797) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-02-21 |