| NPI | 1477864080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301507699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A122648) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2025-02-26 |