| NPI | 1174016935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 21041-875) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A165502) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2021-09-13 |