| NPI | 1376038406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A173916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS t-3592) |
| Enumeration Date | 2018-07-01 |
| Last Update Date | 2021-12-10 |