| NPI | 1659512762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NV 517) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA CA-20A6414) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: PA OS-007153-L) | |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2014-09-09 |