| NPI | 1437204872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2012-02363) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101236884) |
| 207Q00000X Family Medicine (Licence: CA A115957) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2013-04-09 |