| NPI | 1699189670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 56033) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA a147202) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2018-01-09 |