| NPI | 1265957658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18464) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018155) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2021-02-16 |