| NPI | 1497071385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A126088) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME106604) |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2013-12-09 |