| NPI | 1053555029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A 123548) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 53029) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2021-12-21 |