| NPI | 1235323007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C139074) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD435167) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2024-06-18 |