| NPI | 1538245279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A104661) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 23251) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2024-08-08 |