| NPI | 1841386141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 31127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 19516) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2017-02-28 |