| NPI | 1235342957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI dos1460) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A 9866) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2014-12-18 |