| NPI | 1043233158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A69611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301070265) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-01-04 |