| NPI | 1215372297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 187677) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 60256) |
| 207Q00000X Family Medicine (Licence: ND RL12767) | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2023-10-01 |