| NPI | 1447343116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A10161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 34047) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2012-10-19 |