| NPI | 1316065808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ Az H #037) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G-37777) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-08-03 |