| NPI | 1366974024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 16852) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS020568) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2021-08-30 |