| NPI | 1831535228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A24439) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS15279) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2026-08-12 |