| NPI | 1063891190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A150984) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 67046) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2023-12-01 |