| NPI | 1891744538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A51621) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A51621) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2011-06-24 |