| NPI | 1154632636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A122878) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: CA A122878) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2024-08-06 |