| NPI | 1831182591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A9700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 056210) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2024-05-07 |