| NPI | 1386093359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A160057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN23660) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2019-09-10 |