| NPI | 1366427064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A72691) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME97139) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2022-09-29 |