| NPI | 1417250358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A115145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101261229) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2022-06-25 |