| NPI | 1740598804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D40217) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A049949) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2024-05-20 |