| NPI | 1740488543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 13007) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116019758) |
| 207Q00000X Family Medicine (Licence: DC DO034331) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2013-12-18 |