| NPI | 1629423926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA c192355) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 58437) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2024-06-24 |