| NPI | 1093456238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A203901) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 83164-20) |
| Enumeration Date | 2022-04-03 |
| Last Update Date | 2025-08-26 |