| NPI | 1649215260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2019046565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G85883) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2023-02-20 |