| NPI | 1699038125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A135564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301100963) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2019-02-01 |