| NPI | 1982636288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G34033) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G34033) |
| 261QU0200X Clinic/Center Urgent Care | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2024-09-06 |