| NPI | 1265902092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 051099) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G81645) |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2018-12-05 |