| NPI | 1518119510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A105830) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A105830) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2012-12-21 |