| NPI | 1235381781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A5618) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5103325-1204) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2008-10-15 |