| NPI | 1942235528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME105937) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A85614) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-07-19 |