| NPI | 1720048168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD24036) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G84835) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2023-12-19 |