| NPI | 1225236946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME97508) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G73588) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2022-03-23 |