| NPI | 1326473133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD166858) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A127172) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2014-10-15 |