| NPI | 1710239223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C55546) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 18238) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2020-04-16 |