| NPI | 1780692814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C19556) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA C19556) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2008-04-22 |