| NPI | 1538806039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A210078) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351049761) |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2026-07-28 |