| NPI | 1073141099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A20566) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A20566) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-10-28 |