| NPI | 1306012935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 102029) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 16775) |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2012-02-15 |