| NPI | 1629238027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A183565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046153) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2024-02-09 |