| NPI | 1851755904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A17060) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 17060) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2021-11-18 |