| NPI | 1366404097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301043497) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C151694) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2021-08-29 |