| NPI | 1770832529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 12946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 207q00000x) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2025-09-02 |