| NPI | 1720152002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A89234) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 45690-20) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2024-05-20 |