| NPI | 1710980206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 24675) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A54922) |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: MO 2003017056) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2010-06-14 |