| NPI | 1295884336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 47674) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G32707) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2013-05-08 |