| NPI | 1659784593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: CA A143948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A143948) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2025-10-28 |