| NPI | 1558318857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G50117) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4127) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2015-07-09 |