| NPI | 1922534189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A206558) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 31043) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2026-08-17 |