| NPI | 1225212566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A100492) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: CA A100492) |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2012-02-29 |