| NPI | 1629456520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A156667) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT208466) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2021-03-02 |