| NPI | 1942284294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 12171) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A88291) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2015-07-23 |