| NPI | 1366458317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G88694) |
| Additional Taxonomies | 174400000X Specialist (Licence: HI 5149) |
| 174400000X Specialist (Licence: CA G88694) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-03-17 |