| NPI | 1609396365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD198552) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 159499) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2025-04-01 |