| NPI | 1356583819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A120882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 252298) |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2023-07-13 |