| NPI | 1417447426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A173954) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL15081) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2022-10-28 |