| NPI | 1619473162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A181656) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.42892) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2024-09-10 |