| NPI | 1003017906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A112617) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN # 11434) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2023-03-07 |