| NPI | 1568672673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A9781) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2024047122) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2025-01-13 |