| NPI | 1528116571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 237866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A76298) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-07-20 |