| NPI | 1790725539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OR MD23319) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C50860) |
| 208D00000X General Practice (Licence: AZ 34719) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-04-10 |