| NPI | 1992024749 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A120627)  | 
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA A120627)  | 
| Enumeration Date | 2010-05-19 | 
| Last Update Date | 2019-11-25 |