| NPI | 1225097991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A22907) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CA A22907) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2012-06-07 |