| NPI | 1346292711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 52185) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A78919) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2013-09-19 |