| NPI | 1851648638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 53332) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A129082) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2020-05-05 |