| NPI | 1881102002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A207065) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-22725) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2026-08-03 |