| NPI | 1366581977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 8075) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A96439) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2022-11-23 |