| NPI | 1447661996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A149212) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 149212) |
| 207Q00000X Family Medicine (Licence: MI 4301105139) | |
| Enumeration Date | 2014-05-17 |
| Last Update Date | 2021-11-17 |