| NPI | 1619590684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A187022) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046014) |
| Enumeration Date | 2020-05-25 |
| Last Update Date | 2024-09-17 |