| NPI | 1558528711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A106287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT187349) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2021-12-20 |