| NPI | 1205039872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C194569) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 35184) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2024-09-09 |