| NPI | 1831340462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16177) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A10574) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2020-08-21 |