| NPI | 1629165329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME80578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A63347) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2026-06-23 |