| NPI | 1447577853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 313280) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A117762) |
| 207Q00000X Family Medicine (Licence: MS 26765) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA A117762) | |
| Enumeration Date | 2010-04-24 |
| Last Update Date | 2021-07-27 |