| NPI | 1336205277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 07896R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C50645) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2014-11-26 |