| NPI | 1316085152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A98738) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 51415) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2012-07-09 |