| NPI | 1417276585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.205439) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A117716) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2021-12-01 |