| NPI | 1184945743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA a43713) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: CA A43713) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2014-10-31 |