| NPI | 1255407318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA 20A10056) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102032316) |
| 207Q00000X Family Medicine (Licence: FL OS0004196) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2008-12-13 |