| NPI | 1669885885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A149859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT207310) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2022-07-21 |