| NPI | 1043241961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 4628) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G46971) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2011-08-12 |