| NPI | 1902851918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 51266) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G67093) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2016-11-23 |