| NPI | 1902087190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 0420012390) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G88844) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2020-09-09 |