| NPI | 1023110301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G79510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4035) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2023-10-26 |