| NPI | 1316922024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A9753) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R7P11) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2014-09-24 |