| NPI | 1548316342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G60578) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G060578) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA G060578) | |
| 208D00000X General Practice (Licence: CA G060578) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2011-12-06 |