| NPI | 1265570816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 22596) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A051042) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-11-20 |