| NPI | 1841251659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G179191) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD044987E) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-12-08 |