| NPI | 1003811969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A102920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2005-0303) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2021-11-04 |