| NPI | 1295115012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16567) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A17055) |
| Enumeration Date | 2015-06-06 |
| Last Update Date | 2024-09-04 |