| NPI | 1790914919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A139101) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD447161) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2021-08-19 |