| NPI | 1255351631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A12227) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS010964L) |
| 207Q00000X Family Medicine (Licence: MN 51812) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2018-04-03 |