| NPI | 1427497262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A168281) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 256385) |
| 207Q00000X Family Medicine (Licence: GA 83096) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2023-03-07 |