| NPI | 1043313992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G69347) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA G69347) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2024-05-23 |