| NPI | 1033520341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A21223) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 288488) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2024-07-25 |