| NPI | 1912983529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G83972) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01052743A) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2022-02-11 |