| NPI | 1295824654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A53896) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A53896) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-07-10 |