| NPI | 1164436408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 6055) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A6055) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2026-06-02 |