| NPI | 1831174184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A103027) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 28465) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2011-11-22 |