| NPI | 1861499709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A44574) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 15008) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2015-09-03 |