| NPI | 1720098429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G58183) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-13166) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-11-30 |