| NPI | 1225101256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 152300) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA CX3200) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2025-01-15 |