| NPI | 1326428137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 18530) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207Q00000X Family Medicine (Licence: CA 1111) | |
| 207Q00000X Family Medicine (Licence: NE 1111) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-08-04 |