| NPI | 1477967024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A156289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 050-T1) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2018-08-08 |