| NPI | 1841035854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 95029545) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA 9502945) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-07-01 |