| NPI | 1760506471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 12239) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G86275) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |