| NPI | 1467531145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A93965) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A93965) |
| 305R00000X Preferred Provider Organization (Licence: CA A93965) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2023-03-07 |