| NPI | 1841473071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD20080080) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A102245) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2014-06-23 |