| NPI | 1578654109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G22621) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: CA G22621) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-09-06 |