| NPI | 1073690277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A95864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 21115) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-12-16 |