| NPI | 1396271912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 67108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A165278) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2025-04-30 |