| NPI | 1184688624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A111568) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 254682) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2010-07-23 |