| NPI | 1679804645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A6186) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS016700) |
| 208D00000X General Practice (Licence: CA 20A6186) | |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2018-05-24 |