| NPI | 1518055490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20a 12218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os 5775) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2013-05-02 |