| NPI | 1164697173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A112533) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17123) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2024-01-02 |