| NPI | 1306229521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD25604) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A146291) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2022-09-29 |