| NPI | 1780843003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A10180) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 213070) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2012-09-04 |