| NPI | 1356781132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A166209) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 25319) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2020-03-24 |