| NPI | 1023539442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A169876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL51201) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2020-09-01 |