| NPI | 1720354863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR md153277) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A71858) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2012-03-22 |