| NPI | 1255669925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 253081) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A112300) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2014-05-01 |