| NPI | 1285093021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A15671) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS 13761) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2022-07-21 |