| NPI | 1417195603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS019559) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10786) |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2022-06-09 |