| NPI | 1396720710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A64024) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME79405) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2022-06-15 |