| NPI | 1699751776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 11009) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A85627) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2026-04-16 |