| NPI | 1073928586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A20460) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 7280) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2024-06-11 |