| NPI | 1639394372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A7766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS645) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |