| NPI | 1407175136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A127923) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT196675) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2014-07-09 |