| NPI | 1407115983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A134369) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: CA 134369) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2022-07-12 |