| NPI | 1801417811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A185870) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351046326) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2024-03-01 |