| NPI | 1235252859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C198812) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 59195) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2026-02-09 |