| NPI | 1265637698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A136989) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 064065) |
| Enumeration Date | 2007-06-16 |
| Last Update Date | 2020-05-20 |