| NPI | 1962427633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C53949) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 2003-0488) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2012-12-07 |