| NPI | 1851369300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2008-01798) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A61854) |
| 207Q00000X Family Medicine (Licence: VA 0101248774) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2011-07-19 |