| NPI | 1265992168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A180121) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: CA A180121) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2023-09-19 |