| NPI | 1841402336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 2682) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G63427) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2007-07-08 |