| NPI | 1902847320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A9334) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A9334) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2016-03-15 |