| NPI | 1760563068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C52451) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35071195G) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2018-03-17 |