| NPI | 1306842232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A8092) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2024-01-06 |