| NPI | 1467515809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA a36372) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA Pa10741) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2024-09-12 |