| NPI | 1790005536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A125965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-7602) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2025-09-30 |