| NPI | 1568877934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A15611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 6891) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2022-01-18 |