| NPI | 1790099919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A125247) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 198266) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2021-12-17 |