| NPI | 1972647170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 61149-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 24005) |
| 207Q00000X Family Medicine (Licence: CA C129763) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2016-06-16 |