| NPI | 1235516675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A24667) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 007738) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2025-11-11 |