| NPI | 1063659951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO1782) |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2018-05-15 |