| NPI | 1013504109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A200340) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CA A200340) |
| 208D00000X General Practice (Licence: CA A200340) | |
| 261QU0200X Clinic/Center, Urgent Care (Licence: CA A200340) | |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2026-07-21 |