| NPI | 1588651582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA G 46294) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 010198) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2012-08-13 |