| NPI | 1780188755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 174162) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-12957) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2021-08-04 |