| NPI | 1245469345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C173261) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD461643) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2023-11-08 |