| NPI | 1427446517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A17092) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS13052) |
| Enumeration Date | 2014-12-26 |
| Last Update Date | 2022-02-28 |