| NPI | 1649699968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A15471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101025821) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-09-23 |