| NPI | 1750875449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A173787) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-0736) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2023-02-17 |