| NPI | 1902358575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A20287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS020382) |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2026-06-02 |