| NPI | 1396893335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 29530) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A90812) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2022-02-22 |