| NPI | 1851708887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A161240) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 62631-20) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2025-09-17 |