| NPI | 1164620522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-15985) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A78019) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2025-11-13 |