| NPI | 1871566778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C52990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01054872) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2021-12-10 |