| NPI | 1427054493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C176308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D56276) |
| 207Q00000X Family Medicine (Licence: MA 249355) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2023-01-09 |