| NPI | 1205365814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 246653) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2026-08-10 |