| NPI | 1497851000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G13537) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G13537) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2011-05-16 |