| NPI | 1154382158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA g89133) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 124060) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2015-01-15 |