| NPI | 1497801013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 45633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A 10493) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2021-06-10 |