| NPI | 1477907905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A17851) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101022830) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2025-06-17 |