| NPI | 1558391052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C50555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 021228) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2014-07-16 |