| NPI | 1326042821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A79731) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD417462) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2021-11-02 |