| NPI | 1831367747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005367) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10079) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2010-07-25 |