| NPI | 1386804177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A131568) |
| Additional Taxonomies | 208D00000X General Practice (Licence: HI 16631) |
| 208D00000X General Practice (Licence: VA 0101246062) | |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2021-05-10 |