| NPI | 1700189404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A114454) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-7780) |
| Enumeration Date | 2010-12-18 |
| Last Update Date | 2019-02-20 |