| NPI | 1699460741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MTL600001731) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0104755) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-08-17 |