| NPI | 1578625364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A20149) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A20149) |
| 207R00000X Internal Medicine (Licence: CA A20149) | |
| 207V00000X Obstetrics & Gynecology (Licence: CA A20149) | |
| 208000000X Pediatrics (Licence: CA A20149) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2017-10-16 |