| NPI | 1699394742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A24606) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: CA 20A24606) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2026-02-04 |