| NPI | 1790197721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2019-0802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A143066) |
| Enumeration Date | 2014-05-26 |
| Last Update Date | 2023-10-18 |