| NPI | 1124144266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A99168) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: CA A99168) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2013-12-10 |