| NPI | 1689019200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A12364) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A12364) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2013-07-16 |