| NPI | 1841399680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101256876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G069535) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2014-09-10 |