| NPI | 1265431449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD28678) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A75168) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2024-10-15 |