| NPI | 1346245669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A048014) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA E98421) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2021-01-26 |