| NPI | 1235130337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA GFE69629) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 41758-020) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-07-08 |