| NPI | 1710155148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A108551) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A108551) |
| 208D00000X General Practice (Licence: CA a108551) | |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2023-02-21 |