| NPI | 1578556809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G22478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 17633) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2012-04-25 |