| NPI | 1447712450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 24557) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A180374) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2026-05-21 |