| NPI | 1932251733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A91676) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A91676) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-02-26 |