| NPI | 1609862358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA c178170) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD424475) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2023-03-07 |