| NPI | 1497732754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 44463) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A88900) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2023-11-27 |