| NPI | 1073722369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A034431) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A34431) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2018-12-19 |