| NPI | 1669483319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A137701) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO PENDING) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2018-09-11 |