| NPI | 1316095284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-36619) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A48509) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2013-07-08 |