| NPI | 1205943446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A101460) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC05060) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2013-07-05 |