| NPI | 1265884191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A160511) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 7699) |
| Enumeration Date | 2016-07-03 |
| Last Update Date | 2019-07-29 |