| NPI | 1295703080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A80056) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2011-01588) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2012-04-25 |