| NPI | 1235139437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A5509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA E49730) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2016-02-22 |