| NPI | 1699017475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA A171338) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2015-0787) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2021-12-20 |