| NPI | 1477711661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 24446) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A104760) |
| Enumeration Date | 2008-05-25 |
| Last Update Date | 2024-08-22 |