| NPI | 1457743536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD192788) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A150467) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2022-02-04 |