| NPI | 1982683199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 15695R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A80689) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2022-09-16 |