| NPI | 1477762037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA A101059) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A101059) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2022-08-29 |