| NPI | 1922357003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A13057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 266939) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2014-02-03 |