| NPI | 1750361952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101249038) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G75381) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2020-12-08 |