| NPI | 1023679917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A176640) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT219234) |
| Enumeration Date | 2019-06-22 |
| Last Update Date | 2025-11-22 |