| NPI | 1821650185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A23693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MDO.82278) |
| Enumeration Date | 2019-07-07 |
| Last Update Date | 2025-05-12 |