| NPI | 1639606130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18400) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-02308) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2021-06-07 |