| NPI | 1417949736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0069949) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA a064662) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2025-06-04 |