| NPI | 1780801738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A9236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS16374) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2025-09-05 |