| NPI | 1629517792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT017886) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2021-06-03 |