| NPI | 1477814788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A139623) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT201579) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2018-05-14 |