| NPI | 1245670009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A142386) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2013021132) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2016-06-29 |