| NPI | 1245316140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR R-4664) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A023579) |
| 207Q00000X Family Medicine (Licence: OR MD 08885) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2007-07-08 |