| NPI | 1790342764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A149695) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PTL1418) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2022-08-04 |