| NPI | 1588899553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME108581) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A121783) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: NC 2012-00287) | |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2015-04-10 |