| NPI | 1720310592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C153842) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 46692) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2026-03-04 |