| NPI | 1003261496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101267090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A162068) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2024-12-20 |