| NPI | 1841442738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A101545) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 13301) |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2020-01-01 |