| NPI | 1639360449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A93342) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A93342) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2021-11-22 |