| NPI | 1790851442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A6891) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A6891) |
| 208D00000X General Practice (Licence: CA 20A6891) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2010-10-27 |