| NPI | 1780763433 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G376930)  | 
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: CA G37693)  | 
| Enumeration Date | 2006-11-03 | 
| Last Update Date | 2017-03-14 |