| NPI | 1043698707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A155979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT208388) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2024-02-05 |