| NPI | 1144584392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A145793) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E9010) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2026-08-31 |