| NPI | 1184892135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 9721) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A9721) |
| 207Q00000X Family Medicine (Licence: CA 2OA9721) | |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2026-02-10 |