| NPI | 1508569104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A204353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 113032) |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2026-09-02 |