| NPI | 1548277767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA G15628) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G15628) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-07-31 |