| NPI | 1396240859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A173615) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD472860) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2024-02-07 |