| NPI | 1588223382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 19656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL82245) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2026-05-21 |