| NPI | 1245262013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A12321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008017351) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2014-08-19 |