| NPI | 1366825622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C202339) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301107141) |
| 208000000X Pediatrics (Licence: FL 138181) | |
| 207R00000X Internal Medicine (Licence: FL 138181) | |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2026-07-23 |