| NPI | 1265690838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 41845) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A101367) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2011-01-28 |