| NPI | 1366562118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G69199) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 8279) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |