| NPI | 1518345453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A17361) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA 20A17361) |
| 208000000X Pediatrics (Licence: CA 20A17361) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2023-04-20 |