| NPI | 1750318283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A18062) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS007370E) |
| 207Q00000X Family Medicine (Licence: ME DO2758) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-07-06 |