| NPI | 1740569409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOS-1461) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A17538) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2022-07-27 |