| NPI | 1295796720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-4548) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A98575) |
| Enumeration Date | 2006-04-01 |
| Last Update Date | 2015-05-12 |