| NPI | 1932690484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A174730) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 1908R76811) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2021-09-03 |