| NPI | 1861487589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C54288) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA md061292l) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2023-01-17 |