| NPI | 1912927286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G75679) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 18222) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-04-24 |