| NPI | 1902804834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 5899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G32113) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2018-07-13 |