| NPI | 1922411453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C167607) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT207209) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-10-08 |