| NPI | 1922453133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A22659) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 64980) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2024-11-15 |