| NPI | 1780995068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A121522) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2010018037) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2021-08-04 |