| NPI | 1508806027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A8922) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A8922) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-12-17 |