| NPI | 1821150657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C167572) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 148213) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2022-06-03 |