| NPI | 1114033594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 10458) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A83018) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2023-12-15 |