| NPI | 1407268550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A148768) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116026787) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2021-12-08 |