| NPI | 1003952797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A7610) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA 20A7610) |
| 208D00000X General Practice (Licence: CA 20A7610) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2014-10-15 |