| NPI | 1184686313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 020A58040) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 4388) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2025-04-11 |