| NPI | 1346601267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 61182) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A150667) |
| Enumeration Date | 2016-03-20 |
| Last Update Date | 2021-11-23 |