| NPI | 1902122237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A123359) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 56709-20) |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2013-09-11 |