| NPI | 1366602963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL DO1500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10918) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2016-01-05 |