| NPI | 1063440840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A62486) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A62486) |
| 208000000X Pediatrics (Licence: CA A62486) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2012-12-20 |