| NPI | 1265886683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A176846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM md2019-0079) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2023-04-13 |