| NPI | 1083607626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G70630) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: HI 6796) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2023-02-20 |