| NPI | 1720152473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 14517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G067514) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2015-08-14 |