| NPI | 1871029462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A16401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS14790) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2019-06-20 |