| NPI | 1689171225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 201810) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 32362) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2026-01-12 |