| NPI | 1760687107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A114868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116019122) |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2012-09-17 |