| NPI | 1649659418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 62036) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A146251) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-03-29 |