| NPI | 1104388180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: CA A180702) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 180702) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-02-05 |