| NPI | 1538501218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A152193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301103805) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2026-09-24 |