| NPI | 1841247327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2010-0809) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A93209) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2015-06-25 |