| NPI | 1497837561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2001-01105) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A8732) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2013-06-05 |