| NPI | 1679767925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A106703) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD432706) |
| 207Q00000X Family Medicine (Licence: MO 2007034473) | |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2017-06-30 |