| NPI | 1841265618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 102060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G75674) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2012-10-22 |