| NPI | 1356596233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: CA A105183) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: CA A105183) |
| 261QU0200X Clinic/Center Urgent Care (Licence: CA A105183) | |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2024-03-21 |