| NPI | 1902331028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A19428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS020680) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2023-01-27 |