| NPI | 1154768588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 111160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A133945) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2023-11-10 |