| NPI | 1689932436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 58322) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A133618) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2023-03-07 |