| NPI | 1063590560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A89677) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-05-19 |