| NPI | 1386727485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C55766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 24192) |
| 207Q00000X Family Medicine (Licence: IL 036.119080) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2014-07-17 |