| NPI | 1457857831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A164255) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD473425) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2024-04-26 |