| NPI | 1912963331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A96435) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A96435) |
| 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA A96435) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2013-08-30 |