| NPI | 1235147380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 41442) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A65918) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2017-10-31 |