| NPI | 1760529176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A53036) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A53036) |
| 207R00000X Internal Medicine (Licence: CA A53036) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2011-03-25 |