| NPI | 1023500527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A175609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 1908R76804) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2023-01-14 |