| NPI | 1548337918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 86193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A122084) |
| 207Q00000X Family Medicine (Licence: GU MTL-2024-005) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2024-05-09 |