| NPI | 1356499156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A8181) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20a8181) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-03-19 |