| NPI | 1235492760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A149340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301100001) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2022-07-21 |