| NPI | 1851386080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A14907) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS8199) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2016-10-05 |