| NPI | 1326244062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A101657) |
| Additional Taxonomies | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL ME98939) |
| 207Q00000X Family Medicine (Licence: CA A101657) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2024-06-06 |