| NPI | 1174858583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A11277) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS 10795) |
| Enumeration Date | 2009-10-03 |
| Last Update Date | 2016-04-27 |