| NPI | 1104924448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C192921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 10101) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-04-10 |