| NPI | 1851705602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 170031) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301111354) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2024-02-06 |