| NPI | 1336658921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 18604) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A151782) |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2019-03-14 |