| NPI | 1598905630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 242515) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A108414) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2024-01-12 |