| NPI | 1386291300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351045770) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A176602) |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2024-12-11 |