| NPI | 1265457295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G42212) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA G42212) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-11-18 |