| NPI | 1386737773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A86720) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A86720) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2018-08-03 |