| NPI | 1083909600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20a11760) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL os11205) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2012-06-15 |