| NPI | 1295189728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A162873) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A162873) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2023-12-01 |