| NPI | 1679068506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A174176) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL52609) |
| Enumeration Date | 2018-06-23 |
| Last Update Date | 2022-07-14 |