| NPI | 1811169550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 54448-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A117482) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2013-07-09 |