| NPI | 1871113662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A183626) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301507871) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2023-09-14 |