| NPI | 1871941013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 35034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A142290) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2025-10-16 |