| NPI | 1962481713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 48225) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G459940) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2012-03-01 |