| NPI | 1588778930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A30135) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A30135) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2014-02-04 |