| NPI | 1295485043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A197975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME181105) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2026-08-20 |