| NPI | 1730600388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 169633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301113221) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2020-08-12 |