| NPI | 1760541171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R4E85) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA C50423) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2022-03-29 |