| NPI | 1659349173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C138145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0035345) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2024-05-02 |