| NPI | 1487645016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A71300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 13472) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-07-09 |