| NPI | 1780621755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A4859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R2A51) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2018-02-21 |