| NPI | 1841255056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A22842) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-32303) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-04-30 |