| NPI | 1235129198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 12470) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G55836) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2009-11-13 |