| NPI | 1225328818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A128656) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MD D0077352) |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2014-04-29 |