| NPI | 1477647287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G18042) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 2385) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-01-15 |