| NPI | 1588789218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 2OA5193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A5193) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-11-19 |