| NPI | 1710049945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G069218) |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: CA G069218) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-09-10 |