| NPI | 1265653356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C132343) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 47973) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2015-07-22 |