| NPI | 1003377615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A191533) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: CA A191533) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-01-13 |