| NPI | 1598738650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD157389) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A64120) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2015-03-26 |