| NPI | 1508849282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 51010) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A86826) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2021-06-11 |