| NPI | 1154539930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A104106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-20164) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2024-04-17 |