| NPI | 1770645608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A54840) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD10584) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2022-02-10 |