| NPI | 1861707994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A112720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A112720) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2024-02-23 |