| NPI | 1922086552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID MD3222) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G25832) |
| 207Q00000X Family Medicine (Licence: OR MD08869) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2010-03-22 |