| NPI | 1235471319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 11428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C53595) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2016-10-06 |