| NPI | 1316163694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME 017695) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G85787) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2008-02-03 |