| NPI | 1356318216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A66582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO CDRH.0058788) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2025-12-11 |