| NPI | 1659494946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11016) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 243199) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2010-06-07 |