| NPI | 1760845143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A170291) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 266988) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2020-09-30 |