| NPI | 1902348816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA A140627) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A140627) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A140627) | |
| 208D00000X General Practice (Licence: NY 288325) | |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2026-04-17 |